Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
ECMO is a technique for pulmonary bypass, used to support patients with severe respiratory and or cardiac failure who are not responsive to conventional therapy. The idea is to allow the lungs time to heal with mechanical ventilation being reduced to minimum levels. Through large bore canulas unoxygenated blood is removed from the body, passed through the ECMO circuit which oxygenates the blood, and then reintroduced into the body through a large bore canula. The most common indications for ECMO are meconium aspiration, congenital diaphragmatic hernia and neonatal pneumonia which are severe enough to result in pulmonary hypertension and right to left shunting.
The Endotracheal tube (ETT), Nasogastric tube (NGT), Feeding tube (FT), Central venous line, Umbilical arterial catheter (UAC), and Umbilical venous catheter (UVC) tips should be in their normal positions. The tips of the ECMO arterial and venous catheters are often non-opaque, and their exact positions are often difficult to ascertain.
In arterial-venous (AV) ECMO the tip of the arterial catheter should be within the aortic arch and the tip of the venous catheter should be within the right atrium.
In venous-venous (V-V) ECMO the tip of the sole venous catheter should be within the right atrium pointing towards the tricuspid valve.
Body wall edema is present because the patient is paralyzed while on the ECMO circuit.
The lungs are opaque due to a combination of fluid in the alveoli, atelectasis, and effusion.
See References Chapter.
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